Colour Doppler study of uterine artery between 10-14 weeks of gestation as a predictor of intra-uterine growth restriction and preeclampsia

Background: Successful pregnancy is a result of countless ongoing interactions between the placental and the maternal immune and cardiovascular systems. Pre-eclampsia and intrauterine growth restriction (IUGR) remains important causes of maternal and neonatal morbidity and mortality. These conditions arise from placental insufficiency which can be seen as alterations in waveforms in the uterine artery (UtA) in early pregnancy. We investigated the predictive accuracy of UtA Doppler indices for both conditions in the first trimester early enough to provide a window for preventive interventions.Methods: It was a prospective cohort study. (UtA) Doppler was carried out at 11-14 weeks in 100 singleton pregnancies attending for routine care. The right and left UtA were identified and velocity waveforms were obtained. Mean pulsatility index (PI), mean resistance index (RI) and diastolic notch were noted. Results were tabulated and analyzed.Results: 18% developed Preeclampsia and 16% developed IUGR. The first trimester UtA mean RI and mean PI were significantly higher in patients who are destined to develop Preeclampsia and IUGR. No significant relationship was found between IUGR, Preeclampsia and diatolic notch. Mean RI is a better predictor of IUGR and Pre-eclampsia compared to Mean PI. Using receiver operating characteristics (ROC) curve, the best cut-off of mean RI to detect the Pre-eclampsia and IUGR is 0.68.Conclusions: UtA Doppler at 11–14 weeks of gestation identifies a high proportion of women who will develop severe pre-eclampsia, and/or IUGR

Knowledge, attitude and practices about cervical cancer screening among nursing staff in rural tertiary care center

Background: Cervical cancer is the second most common cancer among women worldwide.  The knowledge and attitude of nursing personnel towards cervical cancer screening can grossly influence the community. As the doctor to patient ratio is low in India, staff nurses if trained can act both as health educators and service providers. Objectives of the study were to determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among staff nurses.Methods: In this cross-sectional study sample of 100 nurses was selected randomly out of the total 445 nurses employed in the hospital at a rural tertiary care centre from August 2016 to October 2016. A self-administered, structured, open ended and pretested questionnaire comprising of questions on the general characteristics, awareness, perceptions and actual practices of nursing personnel was used to gather information about cervical screening.Results: In this study, 82% knew that Pap smear can detect cancer. About 48% knew that it can present as post-menopausal bleeding and 32% of the respondents knew that HPV is a risk factor for cancer cervix, but only 30% knew about HPV vaccine and only 35% have ever been screened.Conclusions: The study showed that, knowledge about cancer cervix, screening and practice of Pap smear is low among nursing staff. There is an urgent need for integration of cervical cancer prevention issues in the nurses existing training curriculum

Comparative study of oral iron (ferrous sulphate) versus intravenous (iron sucrose) therapy in treating iron deficiency anaemia in puerperium

Background: Iron deficiency anaemia is one of the major morbidities during post-partum period. The aim of this study was to compare the efficacy, safety and compliance of intravenous iron sucrose complex with oral Iron therapy in treatment of postpartum anemia.Methods: 100 postpartum anaemic patients randomized into two groups. In Group I oral iron ferrous sulphate tablets twice daily and in group II 200 mg of iron sucrose on every alternate day up to total calculated dose for 6 weeks. Hemoglobin and serum ferritin were measured on day 0, 2 week and 6 weeks. The side effects in both groups were noted.Results: Majority of patients are multiparous, illiterate and belonged to low socioeconomic. Mean baseline hemoglobin in oral group (Group I) was 7.90±0.905 gm /dl and in i/v group (Group II) was 7.81±0.849 gm /dl. There was significant rise in hemoglobin and hematocrit in both groups after 2 weeks and 6 weeks. However, efficiency of iron sucrose was greater in between the groups (p value=0.0000). There was a rise in serum ferritin to 58.35±14.537μg/L from 8.30±1,461μg/L after 6 weeks in intravenous group with shorter duration of treatment indicating a high efficacy (p<0.001). Intravenous iron sucrose did not result in any serious adverse reactions.Conclusions: This study illustrates clearly that intravenous iron sucrose complex is safe, convenient and effective in postpartum anemic women as compared with oral ferrous sulphate

Study of prevalence of maternal anaemia and its fetal outcome at rural tertiary care centre

Background: Anaemia is a major public health problem especially among low socioeconomic class of the population in developing countries. Prevalence of anaemia among pregnant women in developing countries is 51%. Anaemia is defined by the WHO as haemoglobin levels of less than 11 gm. %   in pregnancy. The present study was aimed to find out prevalence of anaemia in rural tertiary care centre to see the foetal outcome in anaemic women.Methods: This is a retrospective observational study done in the Department of Obstetrics and Gynaecology, University of medical sciences Saifai, Etawah from June 2017 to November 2017. All the women admitted to labour room in third trimester and delivered here were included in the study excluding the patients with pre-eclampsia, eclampsia, gestational diabetes mellitus, heart disease, patients with other medical disorders and patients with twin pregnancy, antepartum haemorrhage and the patients who did not deliver here.Results: Prevalence of anaemia was 87.3 %. severe anaemia was found in 3.5 % women. The percentage of preterm births was more in anaemic women that is 16.9 %.Conclusions: Anaemia in pregnancy is a major public health problem in India. The number of IUGR and LBW babies were more in anaemic women. Anaemia is related to serious consequences in mother and baby if not diagnosed and treated timely. It can be prevented by increasing the awareness regarding need of iron intake during pregnancy

Cross sectional study for contraceptive practices in antenatal women at tertiary rural institute

Background: Objective of the study was to assess the awareness and acceptance for contraceptive practices amongst the women attending the routine antenatal outpatient services at our tertiary rural institute.Methods: It was a cross sectional study done in UP University of Medical Sciences (UPUMS) Saifai. Three hundred fifty (350) patients aged between 18 -40 years were enrolled in the study after written informed consent. A self structured pre formed questionnaire was provided regarding demographic profile, obstetric profile, contraceptive practices and reasons for not using any contraception. Then data were analysed statistically.Results: Majority of the women were between the age group of 30-35 years and had basic level of education. In our study 90% women were aware of one or more methods of contraception. 86.5% accepted the contraceptive practices and 81.43% followed the contraception. 81.43% used temporary methods of which OCPs, IUCDs, and Condoms were common.Conclusions: Majority of the women were between 30-35 years of age. 90% women knew about some method of contraception. 81.4% women followed the temporary method of contraception. Among non users the main reason for not using contraceptive method were mainly lack of knowledge and they wanted more children

A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population

Background: Premature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions. PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management.Methods: The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis.Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups.Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group

Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patientsMethods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.

A rare case of repeated expulsions of a giant cervical fibroid per vaginum followed by delivery of near term babies in two consecutive pregnancies

Huge cervical fibroid polyp with red degeneration, obstructing birth canal might be a night mare for obstetricians. Most of us will plan for a caesarean section but somehow due to lack medical consultation; a patient in rural setup with a huge cervical fibroid, delivered normal in two consecutive pregnancies. This case is unique because no such case has been reported in literature where normal delivery took place twice in the same patient, with such a huge fibroid with red degeneration, obstructing the birth canal

A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population

Background: Premature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions. PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management.Methods: The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis.Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups.Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group